UTA NURS 4325 - Origins of Evidence-Based Practice

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14 | International Journal of Childbirth Education | Volume 32 Number 2 April 2017Origins of Evidence-Based Practice and What it Means for Nursesby Emily J. Brower, MSN RN CEN, and Rebbecca Nemec, MSN RNAbstract: Evidence-based practice is a term used throughout multiple disci-plines in healthcare to describe the use of research in clinical decision making. However, despite its frequent usage in healthcare vernacular, there remains a gap between the understanding and ap-plication of evidence-based practice. In an effort to assist in transforming evi-dence-based care from a buzz word into a guiding framework for clinical practice, the origins, evolution, rationale and use of evidence-based practice are explored and a case study is provided. Keywords: evidence-based practice, application to practice, historyEvidence-based practice (EBP) is a term that has come into frequent use in healthcare. It is the driving force for many quality improvement initiatives and the standardiza-tion of healthcare practices and policies (Stevens, 2013). In addition, an Institute of Medicine report encourages EBP by requiring 90% of clinical decisions by the year 2020 to be based on this approach (Olsen, Aisner & McGinnis, 2007). With such a robust goal, it is imperative to have up-to-date knowledge regarding the implementation of EBP. Even so, confusion and uncertainty exists surrounding the concepts involved (Melnyk, 2012). In addition, many healthcare pro-fessionals are not clear on the meaning of EBP on a practi-cal and personally applicable level, and face barriers when attempting implementation (Boswell & Cannon, 2017, p. 42; Spruce, 2014). This article aims to explicate EBP from the history of its origin to present day application. The History of Evidence-Based PracticeIn order to more fully understand EBP, a brief review of its origins is helpful. The initiation of EBP has been traced to the mid-1800s. In the field of nursing, Florence Nightingale has been credited with first evaluating and making decisions based on observed outcomes (Mackey & Bassendowski, 2016). One example of Nightingale’s work was the use of hot water and soap as the most effective way to cleanse skin, in comparison with cold water with soap or cold water without soap. Another Nightingale example was the consideration of age and sex into the treatment plan for patients. She was surprised when physicians suggested a similar outcome for patients, regardless of their demographics (Mackey & Bas-sendowski, 2016). Nightingale managed, despite limitations to the body of knowledge at the time, to make changes in an effort to improve patient outcomes. Claude Bernade, a physiologist in the 1800’s, was another early proponent of using scientific evidence to support medical knowledge (Keller, 2012; Morabia, 2006). Bernade aimed to advance medicine past its existing status as an art that was primarily directed by intuition (Morabia, 2006). Continuing into the 20th century, the majority of medical decisions were based upon physician assessments and choices. The realization that many physicians were practicing quite differently, despite similar patient scenarios, led to the next step in the develop-ment of EBP (Mackey & Bassendowski, 2016). Archibald Cochrane, a Scottish physician, was able to recognize the errors and lack of efficiency existing in medicine at the time. The widespread use of controlled randomized trials and the effort to provide a more uniform approach to medical deci-sion-making began in the 1970s. Evidence-based medicine was formally introduced in a series of articles published by Cochrane in 1992 (Keller, 2012). These publications sparked an ongoing trend of defining, implementing, and improving what is now called Evidence-Based Practice. continued on next pageVolume 32 Number 2 April 2017 | International Journal of Childbirth Education | 15The Evolution to a Current Definition of EBPWith the basic constructs of EBP in place, Dr. David Sackett addressed skepticism surrounding the new ideas of research grounded healthcare and formalized the widely ac-cepted definition of EBP (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996; Keller, 2012; Stevens, 2013). Sackett et al., (1996) stated that health professionals should apply “the conscientious, explicit and judicious use of current best evi-dence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research” (p. 1). While this definition and concept may seem routine today, at the time it was a revolutionary. Sackett identified that experience from clinical expertise was of value if used concurrently with the best research. This definition has since been expanded to include the addition of a third concept: patient preference. In 2000, Sackett and colleagues published an article defining a third concept acknowledg-ing personal preference, unique concerns, expectations and values in a patient’s care (Sackett et al., 2000). Thus, EBP can be identified as a combination of three concepts: clinical expertise, best research and patient preferences (Spruce, 2015; Sackett et al., 2000).The Expansion of EBP to Other DisciplinesWhile EBP originated from the nursing and medical disciplines, it has since expanded to many other professions including some outside of healthcare (Rahman & Apple-baum, 2010). In fact, the field of education adopted the con-struct of EBP as early as 1998 (Biesta, 2007). The specifics of EBP implementation differ for various disciplines, yet the fo-cus still revolves around practice guided by solidly grounded research. Other disciplines that have sought research-based quality improvement, and thus EBP, include physical therapy, audiology, speech-language pathology, dentistry, social work, and information science (Hempenstall, 2014). The use of EBP amongst multiple disciplines helps confirm its validity as well as expanding the potential for increased interdisci-plinary collaboration. Why is EBP Important?There are many objectives motivating efforts to increase the implementation of EBP. The Institute of Medicine (IOM) focuses on improving health care quality in order to increase positive outcomes through consistent use of research based knowledge. The IOM has issued a challenge to change the way nursing is practiced by bridging the chasm between research knowledge and practice (Stevens, 2013). It has been

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